· Te Anatomi Whaihua
Kei mua o te scapula te fossa subscapular, te wāhi e tīmata ai te uaua subscapularis. Kei muri ko te scapula e haere ana ki waho, ā, e paku piki haere ana, e wehea ana ki te fossa supraspinatus me te fossa infraspinatus, hei hononga mō ngā uaua supraspinatus me infraspinatus. Ko te pito o waho o te scapula ko te acromion, e hanga ana i te hononga acromioclavicular me te pito acromion o te clavicle mā te whakamahi i tētahi mata hononga porowhita roa. Ko te taha o runga o te scapula he kōhao iti āhua-U, e whiti ana i tētahi hononga suprascapular whakawhiti poto engari pakari, e haere ana te io suprascapular i raro, ā, e haere ana te uaua suprascapular i runga. Ko te taha taha (te taha axillary) o te scapula te mea matotoru rawa atu, ā, e neke ana ki waho ki te pūtake o te kaki scapula, e hanga ana i tētahi kōhao glenoid me te taha o te glenoid o te hononga pakihiwi.
· Ngā tohu
1. Te tango i ngā pukupuku pai o te hope.
2. Te tango ā-rohe i te pukupuku kino o te scapula.
3. Te teitei o te scapula me ētahi atu āhua hē.
4. Te tango i te wheua mate i roto i te osteomyelitis scapular.
5. Te mate mau o te io o runga i te kāpara.
· Te tūnga o te tinana
Tūnga takoto-haurua, whakatītahahia ki te 30° ki te moenga. Ka takaihia te peka o runga e pāngia ana ki te tauera parakore kia taea ai te neke i ngā wā katoa i te wā e pokangahia ana.
· Ngā taahiraa whakahaere
1. Ko te tikanga, ka tapahia he tapahi whakararo i te taha o te scapula i roto i te fossa supraspinatus me te taha o runga o te fossa infraspinatus, ā, ka taea te tapahi whakaroa i te taha waenga o te scapula, i te taha waenga rānei o te fossa subscapularis. Ka taea te whakakotahi i ngā tapahi whakararo me te whakaroa hei hanga i te āhua-L, te āhua-L whakahurihuri, te āhua karaehe tuatahi rānei, i runga i te hiahia kia kitea ngā wāhanga rerekē o te scapula. Mena ko ngā kokonga o runga me raro anake o te scapula me whakaatu, ka taea te tapahi iti i ngā wāhi e rite ana (Pikitia 7-1-5(1)).
2. Tāia te papa o runga me te papa hohonu. Ko ngā uaua e piri ana ki te tihi o te scapula me te rohe o waenganui ka tāia ki te taha whakarunga, ki te taha roa rānei, kia rite ki te taha o te tāia (Pikitia 7-1-5(2)). Ki te mea ka whakaatuhia te fossa supraspinatus, ka tāia tuatahitia ngā muka o te uaua trapezius waenga. Ka tāia te periosteum ki te mata wheua o te gonad scapula, me te paparanga ngako angiangi i waenganui i ngā mea e rua, ā, ka whakaatuhia te papa supraspinatus katoa mā te tango i te uaua supraspinatus i raro i te periosteal, me te uaua trapezius i runga ake. I te wā e tāia ana ngā muka o runga o te uaua trapezius, me tūpato kei pakaru te io parasympathetic.
3. Ina puta te io o te suprascapular, ko ngā muka anake o te taha waenga o runga o te uaua trapezius ka taea te kume ki runga, ā, ka taea te kume mārire i te uaua supraspinatus ki raro, me te kore e tangohia te kiko, ā, ko te hanganga mā kanapa e kitea ana ko te hononga whakawhiti suprascapular. Kia kitea, kia tiakina hoki ngā oko toto me ngā io o te suprascapular, ka taea te tapahi i te hononga whakawhiti suprascapular, ā, ka taea te tirotiro i te notch scapular mō ngā hanganga rerekē, ā, ka taea te tuku i te io o te suprascapular. Hei whakamutunga, ka tuia anō te uaua trapezius kua tangohia kia piri ki te scapula.
4. Ki te mea ka whakaatuhia te wāhanga o runga o te fossa infraspinatus, ka taea te tapahi i ngā muka o raro me waenga o te uaua trapezius me te uaua deltoid i te tīmatanga o te tihi scapular ka hoki whakamuri ki runga, ki raro hoki (Pikitia 7-1-5(3)), ā, i muri i te whakaaturanga o te uaua infraspinatus, ka taea te tihore i raro i te periosteal (Pikitia 7-1-5(4)). Ina whakatata atu ki te pito o runga o te taha axillary o te scapular gonad (arā, i raro i te glenoid), me aro nui ki te io axillary me te uaua humeral rotator o muri e haere ana i roto i te foramen quadrilateral e karapotia ana e te teres minor, teres major, te upoko roa o te triceps, me te kaki pokanga o te humerus, me te uaua rotator scapulae e haere ana i roto i te foramen tapatoru e karapotia ana e ngā tuatahi e toru, kia kore ai e whara i a rātou (Pikitia 7-1-5(5)).
5. Hei whakaatu i te taha waenga o te scapula, whai muri i te tapahi i ngā muka o te uaua trapezius, ka hoki whakamuri ngā uaua trapezius me supraspinatus ki runga, ki waho hoki mā te tango i te taha raro o te periosteal hei whakaatu i te taha waenga o te fossa supraspinatus me te taha o runga o te taha waenga; ā, ko ngā uaua trapezius me infraspinatus, me te uaua vastus lateralis e piri ana ki te koki o raro o te scapula, ka tangohia i raro i te periosteal hei whakaatu i te taha waenga o te fossa infraspinatus, te koki o raro o te scapula, me te taha o raro o te taha waenga.
Pikitia 7-1-5 Ara o te whakaaturanga o te hope o te tuara
(1) te tapahi; (2) te tapahi i te aho uaua; (3) te tapahi i te uaua deltoid mai i te scapula; (4) te hiki i te uaua deltoid hei whakaatu i te infraspinatus me te teres minor; (5) te tango i te uaua infraspinatus hei whakaatu i te taha tuara o te scapula me te anastomosis vascular
6. Ki te mea ka whakaatuhia te fossa subscapular, me tihore i te wā kotahi ngā uaua e piri ana ki te paparanga o roto o te rohe waenga, arā, te scapularis, ngā rhomboids me te serratus anterior, ā, ka taea te hiki i te scapula katoa ki waho. I te wā e wetekina ana te rohe waenga, me āta tiaki i te peka heke o te uaua carotid whakawhiti me te io scapula dorsal. Ko te peka heke o te uaua carotid whakawhiti e ahu mai ana i te kaki thyroid, ā, ka haere mai i te koki o runga o te scapula ki te koki o raro o te scapula mā te scapularis tenuissimus, te uaua rhomboid me te uaua rhomboid, ā, ka hangaia e te uaua rotator scapulae he whatunga toto nui i te taha tuara o te scapula, nō reira me piri pūmau ki te mata o te wheua mō te tihore i raro i te periosteal.
Wā tuku: Whiringa-ā-rangi 21-2023
